The application of SHCP ameliorated cerebral injury for the ECPR rats. A-C, Levels of S100β, NSE, and UCH-L1 serum concentrations in Sham (n = 6), ECPR (n = 12), and CP-ECPR (n = 12) groups. A significant decrease of the biomarkers observed in the CP-ECPR group compared with those in the ECPR group. (D) Damaged neurons identified by H&E staining in representative hippocampal CA1 and CA3 regions (arrows; scale bars represent 50 μm) in each group (n = 5 per group). No neuronal injury observed in the Sham group. Compared with the CP-ECPR rats, a larger number of damaged neurons could be seen in the ECPR group. E, Pathologic scores in the hippocampal CA1 region for each group (n = 5 per group). Pathologic scores of the CP-ECPR group are lower than those of the ECPR group. F and G, Large number of pyramidal neurons in the hippocampal CA1 and CA3 regions of the Sham group using Nissl staining. Clear cell boundaries and abundant Nissl bodies could be observed. The number of surviving pyramidal neurons in the hippocampal CA1 area robustly increased in the CP-ECPR rats compared with that in the ECPR group (n = 5 per group) (scale bars represent 50 μm). Graphs represent means ± standard deviation or median with 25th and 75th percentile. The box-and-whiskers dot plots include the minimum value, the lower quartile (25th percentile), the median, the upper quartile (75th percentile), and the maximum value. SHCP, Selective hypothermic cerebral perfusion; S100β, S-100β Protein; NSE, neuron-specific enolase; ECPR, extracorporeal cardiopulmonary resuscitation; UCH-L1, ubiquitin C-terminal hydrolase-L1; CP-ECPR, SHCP combined ECPR; H&E, hematoxylin–eosin.